ARTIFICIAL URETHRAL SPHINCTER (AUS)
First introduced in 1972, revision rates at 1, 2, 3 years 90-94%, 88%, 81% respectively, with DM and ASA score significant risk factors shown in one prospective study. Radiation, penoscrotal approach are also risk factors for revision. As time progresses since AUS placement, here is generally a decline in continence status and QOL that begins within 1 year after placement. (3). At 5 years the revision rate is 59% to 79%. (4,5,6,7,8)
Most patients are satisfied with 73-90% satisfaction rate. Up to 65% of radical prostatectomy have incontinence. ICS as of 2018 recommends bladder neck implatation in neurological cases because of risk of perineal pressure sore in wheelchair population. This requires a more technically demanding approach including lower abdominal incision, bladder neck exposure and circumferential dissection of the junction between prostate and bladder.(9)
Transcorporeal AUS reimplantaiton may not decrease complicaitons after radiation. (10)
- Liu, Zhishun, et al. "Effect of electroacupuncture on urinary leakage among women with stress urinary incontinence: a randomized clinical trial." Jama 317.24 (2017): 2493-2501.
- Abo Youssef, Nadim, et al. "Cannabinoids for treating neurogenic lower urinary tract dysfunction in patients with multiple sclerosis: a systematic review and meta‐analysis." BJU international 119.4 (2017): 515-521.
- Kaiho, Yasuhiro, et al. "Surgical and patient reported outcomes of artificial urinary sphincter implantation: a multicenter, prospective, observational study." The Journal of urology 199.1 (2018): 245-250.
- Viers, Boyd R., et al. "Long-term quality of life and functional outcomes among primary and secondary artificial urinary sphincter implantations in men with stress urinary incontinence." The Journal of urology 196.3 (2016): 838-843.
- Suh, Yoon Seok, et al. "Long‐term outcomes of primary implantation and revisions of artificial urinary sphincter in men with stress urinary incontinence." Neurourology and urodynamics 36.7 (2017): 1930-1937.
- Léon, Priscilla, et al. "Long‐term functional outcomes after artificial urinary sphincter implantation in men with stress urinary incontinence." BJU international 115.6 (2015): 951-957.
- Lai, H. Henry, et al. "13 years of experience with artificial urinary sphincter implantation at Baylor College of Medicine." The Journal of urology 177.3 (2007): 1021-1025.
- Raj, Ganesh V., et al. "Outcomes following revisions and secondary implantation of the artificial urinary sphincter." The Journal of urology 173.4 (2005): 1242-1245.
- Wingate, Jonathan T., et al. "Multicenter analysis of patient reported outcomes following artificial urinary sphincter placement for male stress urinary incontinence." The Journal of urology 199.3 (2018): 785-790.
- Moser, Daniel C., et al. “Impact of Radiation and Transcorporeal Artificial Sphincter Placement in Patients with Prior Urethral Cuff Erosion: Results from a Retrospective Multicenter Analysis.” The Journal of Urology, vol. 200, no. 6, 2018, pp. 1338–1343.